原发性甲状旁腺功能亢进的影像诊断进展

原发性甲状旁腺功能亢进的影像诊断进展高硕①临床上甲状旁腺功能亢进分为原发性、继发性和三级甲旁亢三类。前者分为腺瘤、增生和腺癌。其中腺瘤占８０％～９０％，增生占１０％～１５％，腺癌占１％～４％。诊断原发甲旁亢主要依据血钙和甲状旁腺激素（ＰＴＨ）的水平，...     

高频彩超对继发性甲旁亢鉴别诊断价值

目的:探讨继发性甲状旁腺功能亢进的声象图表现及与其他颈部病变的鉴别诊断价值。材料与方法:60例合并有甲旁亢的慢性肾衰患者进行甲状旁腺超声检查,总结继发性甲旁亢时增大的甲状旁腺的声像图表现,并与结节性甲状腺肿、颈部淋巴结的超声声像图相比较鉴别。结果:60例继发性甲旁亢时增大的甲状旁腺超声检出率为86.7%(52/60),有一些特征性的声像图表现,41例有结节性甲状腺肿,39例检出肿大淋巴结。结论:继发性甲旁亢时甲状旁腺的声像图有一些特征性的声像图表现,能与结节性甲状腺肿、颈部淋巴结相鉴别,高频彩超可以作为诊断继发甲状旁腺功能亢进的有效手段,为外科治疗甲状旁腺提供比较准确的影像学依据。     

高频彩超在继发性甲旁亢诊断中的意义

目的 探讨继发性甲状旁腺机能亢进(简称继发甲状旁亢)的超声图象与其他颈部病变的区别。方法 比较继发甲旁亢与结节性甲状腺肿、淋巴结的超声图象。结果 53例终末期肾病合并继发甲旁亢患者中39例甲状旁腺增生;31例有结节性甲状腺肿,32例检出肿大淋巴结。结论 甲状旁腺增生、结节性甲状腺肿、颈部淋巴结的超声图象在形态、大小、内部回声及彩色血流等方面各有特点,运用超声技术可以进行鉴别诊断。     

甲状旁腺机能亢进症─—内分泌系统与代谢疾病（9）

甲状旁腺机能亢进症─—内分泌系统与代谢疾病（９）上海第二医科大学附属瑞金医院内分泌科崔贤德甲状旁腺机能亢进症（甲旁亢）是由于一个或一个以上甲状旁腺过度分泌甲状旁腺激素（ＰＴＨ），高血钙不能抑制其分泌，致使血ＰＴＨ增高。疾病的早期往往无明显临床症状成有...     

继发性甲状旁腺功能亢进的超声图像分析

目的：为了给临床诊断、治疗继发性甲状旁腺功能亢进（甲旁亢）提供可靠依据,观察分析继发性甲状旁腺增生的多普勒超声图像特点。方法：运用高频彩色多普勒超声观察、分析42例肾功能衰竭患者临床确诊的继发甲旁亮患者增生的甲状旁腺。结果：共检出31例患者76个甲旁腺增大,内呈低无回声;其周围及内部有丰富的动静脉血流。结论：1.超声检查甲状旁腺可为临床诊断治疗甲旁亢提供可靠信息;2.增生的甲状旁腺主要应与甲状旁腺腺瘤与颈部淋巴结鉴别;3.甲状腺疾病与异位甲状旁腺可影响超声对增生的检出甲旁腺。     

甲状旁腺腺瘤的影像学研究进展

甲状旁腺腺瘤是导致原发性甲状旁腺功能亢进症（简称甲旁亢）的常见病因,其中78％～90％的甲旁亢由甲状旁腺腺瘤所致,且多为单发。诊断本病主要依靠血液生化检查,即表现为血钙的升高以及血磷和骨钙的降低。此外影像学检查也已成为诊断本病必不可少的检查方法,本文就甲状旁腺腺瘤的影像学研究进展进行简要综述。     

超声对慢性肾功能衰竭继发甲状旁腺机能亢进的诊断价值

继发性甲旁亢是慢性肾功能衰竭（ＣＲＦ）患者常见并发症。我们用二维超声、彩色多普勒（ＣＤＦＩ）检测２３例ＣＲＦ患者的甲状旁腺,并以２０例健康人做对照。ＣＲＦ组甲状旁腺检出率９５．６５％,健康人组甲状旁腺均未显示,结果表明超声在继发性甲旁亢的诊断方面有重...     

慢性肾功能衰竭患者继发性甲状旁腺功能亢进的临床特征

继发性甲状旁腺机能亢进（继发甲旁亢）是慢性肾功能衰竭患者常见的重要并发症之一。慢性肾功能衰竭时磷潴留及低钙血症对甲状旁腺的刺激作用,１,２５（ＯＨ）２Ｄ３的缺乏促进了甲状旁腺激素（ＰＴＨ）的分泌,以及甲状旁腺本身分泌控制的紊乱均可发生继发性甲旁亢。研...     

甲状旁腺肿瘤术后血钙血钾1例观察与护理

<正>甲状旁腺分泌过多甲状旁腺素而引起的钙磷代谢失常称为甲状旁腺功能亢进(甲旁亢)。主要表现为骨骼改变、泌尿系统结石、高血钙和低血磷等。由甲状旁腺本身病变(肿瘤和增生)引起者,称为原发性甲状旁腺功能亢进症。甲旁亢患者由于甲状旁腺素分泌过多促进破骨细胞活性增加,动员骨钙释放人血引起高钙血症。同时甲旁亢还会出现低钾性周期性麻痹[1]。     

继发性甲状旁腺功能亢进的超声引导下介入性治疗

目的：探讨超声引导下介入性治疗继发性甲状旁腺功能亢进（甲旁亢）的疗效与价值。方法：观察、比较33例患者经超声引导无水酒精硬化治疗前后血清PTH水平的变化及甲状旁腺超声图像变化，评价其治疗效果。结果：33例患者经治疗后，其血清PTH全部明显下降。缓解率15.2%(5/33)，显效率54.5%(18/33)，满意率30.3%（10／33）。结论：超声引导下经皮注入无水酒精治疗继发甲旁亢是一项安全、有效的治疗手段，值得推广使用。腺体内血流信号的变化是观察疗效的敏感指标。对难治性继发甲旁亢患者应采用综合性治疗手段，以巩固、提高疗效。     

Value of serum alkaline phosphatase in evaluating hyperplasia of parathyroid glands in chronic hemodialysis patients

To investigate the value of serum alkaline phosphatase in evaluating hyperplasia of parathyroid glands in hemodialysis patients, 28 hemodialysis patients who had parathyroid sonography examinations for secondary hyperparathyroidism were studied retrospectively. There were significant elevations of serum alkaline phosphatase, parathyroid hormone (PTH), serum total calcium, and dialysis duration in patients with sonography-detectable parathyroid (N = 17) as compared with those of sonography-undetectable (N = 11) parathyroid. Hemodialysis patients who have both higher serum alkaline phosphatase (>94 IU/ L) and considerably elevated serum PTH (9× or higher) are likely to have sonography-detectable parathyroids (positive predictive value of 93%). Patients with mildly or moderately elevated serum PTH but normal serum alkaline phosphatase are less likely to have sonography-detectable parathyroids (negative predictive value is 100%). These findings suggest that the elevation of serum alkaline phosphatase could be a valuable parameter in addition to the high serum PTH level in predicting hyperplasia of parathyroid glands in chronic hemodialysis patients. © 1994 John Wiley & Sons, Inc.     

高频超声对原发性甲状旁腺疾病的诊断价值

目的：探讨高频超声对原发性甲状旁腺疾病的诊断价值。方法：对100例正常人及30例拟诊为原发性甲状旁腺疾病的患者行甲状旁腺超声检测，检查结果与病理诊断、血清甲状旁腺激素等临床资料综合分析。结果：正常组在20人中发现27个正常甲状旁腺，甲状旁腺的检出率为20％（20／100）。在30例疑为甲状旁腺疾病的患者中超声检出患甲状旁腺疾病者19例，病变甲状旁腺21个，包括甲状旁腺腺瘤、腺癌、无功能囊肿、单纯性甲状旁腺肿大等，假阳性3例；正常甲状旁腺11例，超声检出的最小甲状旁腺直径4．5mm，无假阴性。结论：高频超声不仅能检出10mm左右的甲状旁腺腺瘤，而且可能检出＞5mm正常或轻度肿大的甲状旁腺，为临床除外甲状旁腺疾病首选的可靠方法。     

继发性甲状旁腺功能亢进症彩色多普勒超声学诊断意义及临床分析

目的 观察彩色多普勒超声探测维持性血液透析继发性甲状旁腺功能亢进症患者增殖腺体的数目及超声信号特点。方法 86例患者分为透析时间<8年组、透析时间≥8年两组。以彩色多普勒超声探测增殖腺体的数目、腺体的长、宽、厚以及腺体超声信号,计算腺体体积、记录血清学指标及超声图像。外科切除的腺体送病理检查。结果 不同透析时间的2组患者,增殖腺体的数目、腺体的体积、甲状旁腺激素水平及血磷存在统计学差异。透析时间<8年组甲状旁腺激素与增殖腺体的总体积之间无相关性,≥8年组甲状旁腺激素与增殖腺体的总体积之间存在相关性。病理检查示:腺体以节结节样增殖为主,主细胞及嗜酸性细胞均可见明显增殖。结论 以彩色多普勒超声行继发性甲状旁腺功能亢进腺体的筛查是一项简单有效的方法,同时也为下一步临床治疗提供依据。     

不同血液净化方式治疗尿毒症患者顽固性高血压的疗效对比分析

目的探讨血液透析联合血液灌流与血液透析滤过治疗尿毒症患者顽固性高血压（resistanthypertension,RH）的临床效果。方法我院2010年12月至2013年5月尿毒症RH患者68例,按随机数字表法分为观察组与对照组各34例,观察组给予血液透析联合血液灌流治疗,对照组给予血液透析滤过治疗,时间均为16周,观察两组血压（包括收缩压、舒张压、平均动脉压）及血管紧张素Ⅱ、甲状旁腺激素、肾功能（肌酐、尿素氮）水平等方面的差异。结果治疗16周后,观察组收缩压、舒张压、平均动脉压、血管紧张素Ⅱ、甲状旁腺激素均低于对照组（P〈0．05）,但两组肌酐、尿素氮水平差异无统计学意义（P〉0．05）。结论血液透析联合血液灌流与血液透析滤过在治疗尿毒症患者RH压方面各有优势,但血液透析联合血液灌流临床效果更加明显。     

难治性继发性甲状旁腺功能亢进症患者病理结果临床分析

目的分析外科手术切除的甲状旁腺标本病理结果,探讨其对难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者的临床意义。方法回顾性分析82例难治性继发性甲状旁腺功能亢进症患者资料,增生甲状旁腺全切患者67例。53例手术前行99mTc-MIBI双时相平面显像和彩色多普勒超声2项检查定位,另外14例手术前仅行彩色多普勒超声检查定位,比较2种影像学检查方法的准确率,并分析术前最后1次血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)与切除的不同病理类型甲状旁腺体积之和的关系。结果手术切除的甲状旁腺标本病理结果为单纯性增生的腺体体积之和与患者术前血清iPTH呈显著正相关(r=0.365,P=0.006),增生伴钙化的甲状旁腺腺体体积之和与术前最后1次血清iPTH无明显相关性(r=-0.308,P=0.356)。99mTc-MIBI平面显像、彩色多普勒超声及两种方法联合检查对增生甲状旁腺定位诊断准确率依次为128/212(60.38%),203/259(78.38%),172/212(81.19%),高频超声相对于99mTc-MIBI平面显像对SHPT的增生腺体准确率比较高(χ2=18.080,P=0.000),有统计学意义。2种检查联合应用的准确率优于多普勒超声(χ2=0.545,P=0.460),无统计学意义,而2种检查联合应用的准确率优于99mTc-MIBI核医学检查(χ2=22.066,P=0.000),有统计学意义。结论术前iPTH值不能完全反应难治性SHPT患者的严重程度,彩色多普勒超声对难治性SHPT增生腺体的筛查是一项简单有效的方法,可作为难治性SHPT外科手术前的首选辅助检查。     

Laboratory screening for hyperparathyroidism

INTRODUCTION: The clinical syndrome produced by excess parathyroid hormone (PTH) is referred to as hyperparathyroidism (HPT). Autonomous growth of PTH producing cells is defined as primary hyperparathyroidism (pHPT). In its classic form pHPT is characterized by painful bones, kidney stones, abdominal groans, psychic moans, fatigue overtones and hypercalcemia. Chronic stimulation of the parathyroid glands secondary to low circulating calcium level results in secondary hyperparathyroidism (sHPT). Tertiary hyperparathyroidism (tHPT) results from prolonged secondary hyperparathyroidism when the glands take on an autonomous function manifested by hypercalcemia and high PTH levels despite resolution of the original stimulus. REVIEW: The paper reviews the physiologic regulation of PTH secretion and types and forms of HPT. Calcium homeostasis is discussed, emphasizing interactions of PTH, PO4 and vitamin D that can lead to HPT. In addition, the paper reviews the contribution of serum calcium, chloride, phosphorus and PTH levels to the diagnosis of HPT, the role of urinary calcium in the diagnosis of familial benign hypocalciuric hypercalcemia (FBHH), and the role of alkaline phosphatase and bone mass measurements as markers of severity of hyperparathyroid bone disease. CONCLUSIONS: It is concluded that the diagnosis of hyperparathyroidism can be made with a very high confidence rate by documenting an increased serum PTH level with an increased ionized or total calcium level in pHPT, increased serum PTH level with low or normal calcium level and an underlying renal failure or vitamin D deficiency in sHPT. Early management of HPT is important because many of the nonspecific complains, or classic symptoms, or metabolic conditions often improve after proper control of hyperparathyroidism.     

血液灌流联合血液透析对行骨化醇冲击治疗的继发性甲状旁腺功能亢进症患者的干预效果

目的分析血液灌流联合血液透析对行骨化醇冲击治疗的继发性甲状旁腺功能亢进症患者的干预效果。方法将80例继发性甲状旁腺功能亢进症患者按照入院治疗时间分为对照组(38例,在骨化醇冲击治疗基础上采用血液透析治疗)和试验组(42例,在骨化醇冲击治疗基础上采用血液灌流联合血液透析治疗)。比较两组治疗前、后的肾功能指标、血钙、血磷、甲状旁腺功能、Klotho水平以及不良反应发生情况。结果治疗后,两组的尿素氮、血清肌酐水平比较,差异无统计学意义(P>0.05)。治疗后,试验组的血钙、Klotho水平明显高于对照组,血磷、甲状旁腺激素、碱性磷酸酶水平明显低于对照组(P<0.05)。试验组的不良反应总发生率明显低于对照组(P<0.05)。结论血液灌流联合血液透析在行骨化醇冲击治疗的继发性甲状旁腺功能亢进症患者中的应用效果显著,能有效改善患者肾功能,且治疗安全性高。     

维持性血液透析的CKD合并SHPT患者甲状旁腺次全切除术后骨密度变化

目的 评估合并继发甲状旁腺功能亢进（SHPT）的慢性肾脏病（CKD）维持性血液透析患者甲状旁腺次全切除术后骨密度变化。方法 收集CKD血液透析后因合并SHPT接受甲状旁腺次全切除术的33例患者（手术组）和37例单纯药物治疗的同类患者（药物组）的临床资料。所有患者治疗前后均接受胸部CT扫描,以胸骨为测量位置,观察CT测量的骨钙积分变化,比较2组血钙、血磷、甲状旁腺激素以及骨密度等数据,分析手术与否和骨密度变化的关系。结果 手术组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异有统计学意义（P均< 0.05）,骨密度升高;药物组治疗前后血钙、血磷、甲状旁腺激素以及骨密度差异无统计学意义（P均> 0.05）。控制了年龄因素后,手术与否和骨密度变化存在相关性（P < 0.05）。结论 对血液透析后出现SHPT的CKD患者实施甲状旁腺次全切除术有助于改善其骨密度。     

长期血液透析患者甲状旁腺的超声观察

目的⑶探讨 Ｂ 型超声对继发性甲状旁腺功能亢进的诊断价值⒚方法⑶选择 ５ ２ 例不同时期维持性血液透析患者⒙应用 Ｂ 型超声测算甲状旁腺体积⒙并与正常人对照⒚结果⑶长期血液透析患者甲状旁腺体积明显大于正常人⒉ Ｐ＜ ００ １⒕⒙透析治疗 ５ 年以上与不足 ５ 年的相比也明显增大⒉ Ｐ＜ ００１⒕⒚部分病例出现同组个体间及同一病例各腺体间的不均衡性增大⒚结论⑶慢性肾衰时伴有持续性甲状旁腺增生⒙ Ｂ 型超声能够确切地观察测定甲状旁腺的病变⒙是一种准确简便的诊断及动态观察继发性甲旁亢的新手段⒚     

Primary hyperparathyroidism with multiple parathyroid gland enlargement: review of 53 cases.

Of 53 patients who had hyperparathyroidism assocated with multiple parathyroid gland enlargement, 39 (74%) had primary hyperparathyroidism without clinical or laboratory evidence of associated endocrine gland dysfunction, 2 had documented familial primary hyperparathyroidism, and 12 had hyperparathyroidism as part of the multiple endocrine neoplasia syndrome. When last studied, 31 of the 39 patients with nonfamilial hyperparathyroidism had normal serum calcium levels, 3 had permanent hypoparathyroidism, 2 had recurrent hyperparathyroidism, and 3 were lost to follow-up. The two patients with familial hyperparathyroidism were treated by removal only of enlarged parathyroid glands, and in each, hyperparathyroidism recurred. Five patients with multiple endocrine neoplasia, type 1, were treated by removal only of enlarged parathyroid glands, and hyperparathyroidism recurred in four. Four patients with multiple endocrine neoplasia, type 1, were treated by removal of three or more parathyroid glands, and there were no instances of recurrent hyperparathyroidism. In one patient, permanent hypoparathyroidism developed. Three patients with multiple endocrine neoplasia syndrome, type 2, had total parathyroidectomies as a part of thyroidectomy for medullary thyroid carcinoma. In each patient, permanent hypoparathyroidism developed. When primary hyperparathyroidism occurs in the absence of a definite history of polyendocrine or familial disease, only the glands that are definitely enlarged should be removed, and normal-appearing glands should be tagged rather than risk the possibility of permanent hypoparathyroidism that may attend routine subtotal parathyroid gland excision.